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NPI Code Detail

MEDICARE: SIERRA JEWELL PTA

MEDICARE: SIERRA JEWELL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantTE011966PA

General Provider Information

NPI Number : 1912564550
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIERRA JEWELL PTA
Provider Business Mailing Address
First Line : 24 VAUGHN RD
Second Line :
City : HADLEY
State : PA
Zip : 16130-2230
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 339 E MAPLE ST
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-2593
Country : US
Telephone Number : 330-498-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2019
Last Update Date : 05/20/2019

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Directions to “ SIERRA JEWELL PTA” Practice Location

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